HomeMy Public PortalAbout6239 SULTANA AVE_Sewer__ APPLICATION FOR PERMIT
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COUI+tTY OF IROS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION BUI!_DING
A - ✓- -
JOHN A. LAIsKBIE, Country' Engineer An�F2ES5 P
WILLIAM A. JENSEN. Sup't of Building
LOcau7v ✓ t 'a: -- — -- --- -
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NEAREST
FOR APPLICANT TO FILL IN CROSS
�'—_LEGAL +�,�y' - +
DE5 R{PT IbN LOT NO R--- _.— OWNER 1 �-:i,• r' _ —' '' 'G. - � --
_ _- _
.� MAIL. gy��`�,
BLOCK
TRACT �"} ADDRESS N'
NO. O.P fSLDGS._____
LOT NOW ON L.<aT CITY TFL. Nom^..
U5E O;
BUILDINGS DISTRICT^iO. GE2.b LiP MA.PPFjb
RK PG ::E" 'SSD BY
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CONTRACTOR f�q� f C" d`. (.tea
ADDREss - F: e- �+Y QT'3'NECTION DATA
STATION ? DEPTH "
FL Nib. TION,
�,* � MANHOLE REFERENCE
,?,�. r-T { s--
REG! TRA71!7 t7 n0 1 _ _ _.._ COU NT4 -' .,P"� f eI LOWERa
No. JESCRkPS{ON OF WORK FE _ �TYPGt]F .ONN�' I LENGTH FROM
I Htri?SE SEWER CON NEc.TING T'7 Y ``^y vt ij M.L TO P.L. 9_
I CHUB C S:EWER@ '#5,40 r07 nt0 —d-
_ - __ _. --
FP IC,TAN K SEEPAGE PI'" O.i
Pi TS AND LN F DR4 NiE.D $SO:00 �.. _-_t IMP
___ ,. _
7 HL)US SF.hI.2 CCNNE�-T'NG TO .� 'l r y%.-
PRIVAT C;SPOSAL SYSTEM S:i,00 TRUNK PERMIT hl U. ROAD PERMIT hi 0, , LO
.. .—.-_— __ ---N,
___ B®
CONNECT 1DDItIONA,BLDG Old AFFIDAVIT Viz-' WAIVER Epsewaaw� RE ORD. INSTR_ NO, 1 _ DATE
t JJ�.RK 70 HOUSE.SEWER ' $3.00 _ I I .� be
t'`✓ERF LCW F_E.PAGE Pf`E DRAINFIELD "
EXTN..CE SPCOt 0RYWEi.L MANHOL.0 C�
$a..OD Z
__ _ — HWY. OR ST-W";I7FNING sG.�
{ AL.ER,REPAIR OR ABARiDJN rt OUST
I Jr`E}3 :R DISPOSAL SVSTFM,..__._ CCS $3.00 � - yYATE LNC RC'AC.HMEN-e"
PERMiT NO.
--------_-------- ___ - - — .____ N7US TR IAL _
I I WR'TE APPROVAL
VFL
OW ERIE PERMIT � C_HAxGES-
—_ . - — - -- --- —
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
REIMBL RSEM;N FEE
1 tiA`/E R7 71�i15 DATE. A CONTRACT 'ViTN THE FiER£!N NAMED CON_
T'R n,CTOP. TO CONN_CY TFic =aBCVE DESCRIBED EX IS'T7NG. DWELLING -_--___—g7.9/_�;._py—�+_-____._.._.x
7'Fi, P"i SL fC r:.wI:R. APPROVALS -AT'E- i INSPECTOR5 SIGNATURE
SIGNED TH.iS-_ DAY ___--------
OW"NER OR NEW HOUSE SEWER
OWNERS
CONNNN ECT ADDITIONAL �
BL1ILD NG OR EEWORK___—,—.—___—
ADDRESS
�.-__—_—
'- SEPTIC TANK,SEEP,PI T('5) �
I HEREBY ACKNOWLEDGE- ,HAT 1 HAVE READ THIS APPLICATION kND.+-Oft URAIN)-IFI.D
AN STA 'E, THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY I
WIT kiALL COUNTY ORDINANCES AND STATE LAWS REGULATING i
1
P{_U AABfNG AND SEW ER 5. CESSPOOL 1 DRYWELLU
I HEREBY' CERTIFY THAT 7 A.�. PROPERLY REGISTERED AND"
OR ALTER,REPAIR,SEWER OR - - -----�—�—- —�-- -" --_"_-
LICENSED AS REQUIRED SY .LOS ANGLES COUNTY AND STATE OF SEWAGE D15 OSAL SYSTEM
.CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO -- - — --- —�`—'—"--�-"- - ---
RESIDE IN, THE `CVE DESLR14�p... E51DENr '1."PRCPE13.T'Y DISCONNECT PLUG AND
Ali .y�a�X 'S ABANDON HOUSE SEWER
SIGNATURE
OF PERMiT'7EELi.SE PY'IC ANK5 J
EEP,PI sl (1 CESSPOOLS O± I
VALIDATION ROBERT A. 'WOOL
SUPERVISING MECHANICAL ENGINEER
Cti Ji M.'0. CASH
� !moi
z APPLICATION FOR PERMIT �?
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL !0
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION TCROSS
ING
j®IIN A. Ld4MBIE, County Engineer
ESS
WILLIAM A. JENSEN, Supt of Building TY.FOR APPLICANT TO FILL IN s,.
_I6CRIPTION LOT NO. � °� OWNER
f_*Y t MAIL. `
_BLOCri - `k? TRACT jlcc .,.•g __ ADOR S.-
NO. OF BLOGS.
5T:'L,E' OF COT NOW ON. LOT CITY TEL. NO.
S
UE OF
BUILDINGS DISTRICT NO. GROUPI MAP PR.QC ES 5 ED B
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s�
CONTRACTORcj✓9Sir
J
ADDRESS y 1.�^ CONNECTION DATA v
TELNO. �+AT!ON ,ff' �' ,v DEPTH .^
C1TYf" >s i ix. .. �' ✓ ,r
9y... �,..{ ^'�1'A7E MAN 11-LE REFERENCE
REGISTRATION NO. [� �i - -
_�. .._. d ^.� ' :-..� CO NTYJ., TOWER -
NO. DESCRIPTi ON OF WORK FEE TYPED'$5.00 ON "C 40Y. LENGTH FROM -
HOUSE SEWER CONNECTTNG O Y. `� _
PUBLIC: EWER @ --�' '�:. P M.L 70 P.L: r
SEPTIC IANK,SEEPAGE PIT OR P C.NO
I TSAND/OR DR:AINNE.L:D @ $10:00 CO. IMP NO. -.. )
JOB NO.
P
HOUSE SEWER 1ONN-CTING TO --
TRUNK PERMIT Na. ROAD PERMIT N:1.
1 PRI VfO T'E DISPOSAL SYS rF.M SL .5300 � �- �
X3.00
G _ ._-... - I WP.IY{R�' EASE\iEkY' I REGARD.iNSTR NG. DATE �y
__... OOVERFLJW LDEEPA ,E P T,SLOG.RAIN FT L tS_00 WYpOR ISC kYiDEN
WORK TO HOUSE.SEWER
EXTN CESST OOH DRYNE LMA -t! INC 44:
ALTER.REPA112 OR ABA^N's o. H. SE, - '
E\'EE2 C DYSPOSAt'S)''SFf'.M '' _$3.00 A F NC BOAC}MENT
----4 :..__ —
PERMIT NO.
INOUSA
--__._ -._.._ ♦•.—..—. _____
WASTE RIA APPROV -- y .-
WASTE � ,yYr,r
O NYNF.E'o-7 PERMIT �y HAR ES
...a CONNEC'I ION CHARGE FEE.
AUTHORIZATION TOTAL FEE � ----------- --
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- -E,M31I -HENT FEE
TRACTOR TO COyi NECY TME :ABOVE DESCRIBED EXi.STING DWELLING -- - --- ------------- -----------
7'O THE. PUBLIC SEWER. APPROVALS DATE �INS:PEC70Yd'S SiGNA7URE.
SIGNED
OWNER OR NEW HOUSE-EWER _
OWNERS AGFNT
— --- - --- I-ONNECT ADDITIONAL
BU'.1_D P u OR WORK
—_ ._—
SEPI
1 II REBY A_KNOWLEDGE THAT I HAVE READ THIS APPLICATION D/ TANK,S_EP, . {S}. II
AND/OR.>RAIN�'IELD
A.NO ..STATE THAT THE ABOVE is CORRECT AND AGREE. 70 COMPLY
WIT'Y ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -----�—
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWEI_L
I HEREBY CERTIFY THAT I AM PROPERLY RFQ;s,r E'RED AND/OR ALTER RFPA'R.SEWER OR
LICENSED AS REQUIRED BY LOS ANGL COUN'7Y AND STATE OF SEWAGE DISPOSAL SYSTEM
GALI IRNA OR '1 Al' 1 4M EGAL WN AND INTEND TO C
REGIDE IN. THEE ED "..I DE NT PrROPERTY. Ot�;. f NNE PLL l AND I`
ABANDON HOUSE.SEWER S'
SIGNATURE
OF PtRMTTTF' 9 SAC KFILL St P7fC TANK ❑
_ —_. _ -.y7'_—e" _ _— SEEP,PED(S) ❑ CESSPOOLS Qi
—VALIDATION ROBERT A. WOOD
M.O. CASH SUPERVISING MECHANICAL ENGINEER
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